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Blais RK, Xu B, Tannahill H, Dulin P. Male sex and hazardous alcohol use following military sexual assault increase suicide risk among US service members and veterans. Eur J Psychotraumatol 2024; 15:2312756. [PMID: 38568596 PMCID: PMC10993746 DOI: 10.1080/20008066.2024.2312756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/20/2024] [Indexed: 04/05/2024] Open
Abstract
Background: Higher alcohol use and military sexual assault (MSA) are associated with increased risk of death by suicide. Risk for death by suicide is rapidly increasing among females, who report higher rates of MSA, yet actual death by suicide and alcohol use are higher among males. It is not well understood whether higher alcohol use confers greater suicide risk in male or female service members and veterans who have experienced MSA.Objective: To determine whether the association between alcohol misuse and suicide risk was moderated by biological sex in a sample of male and female service members (N = 400, 50% female) who reported MSA.Method: Participants completed surveys of alcohol use and suicide risk as well as a demographic inventory. Linear regression with an interaction term was used to determine if suicide risk differed by sex and alcohol use severity after accounting for discharge status, sexual orientation, and age.Results: Average scores on the suicide risk measure were consistent with an inpatient psychiatric sample and scores on the AUDIT-C were indicative of a probable positive screen for alcohol misuse. Suicide risk was most pronounced among males who reported higher levels of hazardous alcohol use. A sensitivity analysis examining suicide risk by sex and screening results for alcohol misuse (positive/negative) showed that men with a probable positive screen had higher suicide risk.Discussion: The current study provides novel findings on suicide risk among survivors of military sexual violence by including both male and female survivors. Interventions to decrease suicide risk following MSA may consider alcohol reduction strategies, and optimizing these interventions in males. Engaging military culture at both the US Departments of Defense and Veterans Affairs to encourage more healthy alcohol consumption may mitigate this public health concern. Future research may consider how country of origin relates to these associations.
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Affiliation(s)
- Rebecca K. Blais
- Psychology Department, Arizona State University, Tempe, AZ, USA
- Psychology Department, Utah State University, Logan, UT, USA
| | - Bingyu Xu
- Psychology Department, Arizona State University, Tempe, AZ, USA
| | - Hallie Tannahill
- Psychology Department, Utah State University, Logan, UT, USA
- Wright-Patterson Medical Center, Wright-Patterson Air Force Base
| | - Patrick Dulin
- Psychology Department, University of Alaska Anchorage, Anchorage, AK, USA
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Diefenbach GJ, Stubbing J, Rice TB, Lord KA, Rudd MD, Tolin DF. Uncovering the role of substance use in suicide attempts using a mixed-methods approach. Suicide Life Threat Behav 2024; 54:70-82. [PMID: 37987548 DOI: 10.1111/sltb.13019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Substance use is an established risk factor for suicide attempt. Clarifying the role of substance use in suicide attempts may identify modifiable treatment targets. This study used mixed methods to associate substance use with suicide attempt history and identify pathways through which substance use contributes to attempts. METHODS Study 1 included 213 adult inpatients (n = 127 with substance use disorder [SUD]), who completed assessments of suicide attempt history as well as demographic and clinical suicide risk factors. Study 2 was a narrative analysis of suicide attempt stories described by 20 inpatients diagnosed with SUD. RESULTS In Study 1, patients with co-occurring alcohol and drug use disorders reported more actual lifetime suicide attempts than did those without SUD. In addition, alcohol and drug use disorders were independently associated with lifetime suicide attempts after controlling for demographic and clinical confounders. In Study 2, substance use played a role in all suicide attempts through at least one pathway before, during, or after a triggering stressor, or as suicide attempt method. CONCLUSIONS Substances play a role in suicide attempt baseline risk, acute risk and as means. It is important to target chronic and acute substance use in suicide prevention treatment plans.
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Affiliation(s)
- Gretchen J Diefenbach
- Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jessica Stubbing
- Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut, USA
| | - Tyler B Rice
- Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut, USA
| | - Kayla A Lord
- Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut, USA
| | | | - David F Tolin
- Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
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Mazulyte-Rasytine E, Grigiene D, Gailiene D. Suicide Risk, Alcohol Consumption and Attitudes towards Psychological Help-Seeking among Lithuanian General Population Men, Conscripts and Regular Active Duty Soldiers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3457. [PMID: 36834153 PMCID: PMC9961175 DOI: 10.3390/ijerph20043457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study was to investigate the relationship between suicide risk, alcohol consumption, and attitudes towards professional psychological help among Lithuanian general population men, conscripts, and regular active duty (AD) soldiers. In total, 1195 Lithuanian adult males participated in the study: 445 men from the general population, 490 conscripts, and 260 regular AD soldiers from the Lithuanian Armed Forces. The study's measures included: general suicide risk, alcohol consumption levels, frequency of using alcohol as a means to suppress difficult thoughts and feelings, and attitudes toward psychological help. Both military samples showed significantly lower suicide risk than men from the general population. Alcohol use as a means to suppress difficult thoughts and feelings was the most significant predictor of suicide risk and a significant mediator between alcohol consumption and suicide risk in all study groups. Another significant suicide risk predictor and mediator between alcohol consumption and suicide risk-i.e., the value of seeking psychological treatment-was found only in the conscript sample. Results of the current study suggest that there is an opportunity for intervention aimed at the attitudes toward seeking professional psychological help for conscripts. However, that might not be the case for regular AD soldiers, nor the general population of Lithuanian men.
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Affiliation(s)
- Egle Mazulyte-Rasytine
- Suicide Research Centre, Institute of Psychology, Faculty of Philosophy, Vilnius University, 01513 Vilnius, Lithuania
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Acute use of alcohol before suicide in Kazakhstan: A population-wide study. J Affect Disord 2023; 321:134-139. [PMID: 36272459 DOI: 10.1016/j.jad.2022.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Acute use of alcohol is a proximal risk factor for suicidal behavior and suicide attempts. Previous studies have established that alcohol consumption prior to suicide increases the risk of suicide completion. Thus, the current study aims to explore the association between alcohol use and suicide mortality in Kazakhstan. This is the first study to address this association in Kazakhstan. METHODS The main outcome measure was the presence of alcohol in blood of suicide decedents. Logistic regression models were used to test unadjusted and adjusted odds ratios of the risk of suicide involving acute use of alcohol. Regression modeling was used to identify significant predictors of alcohol use among suicide decedents. RESULTS Males (22.5 %) used alcohol more commonly before conducting suicide than females (13.4 %). The odds of alcohol involvement was 2.73 times higher for males compared to females after controlling for age and other covariates. Being a male younger than 45 years old and using suicide methods such as poisoning, immolation, and drowning increased the odds of acute use of alcohol among suicide decedents. LIMITATIONS Data on alcohol use included information only on individuals with a positive alcohol test, and it is unknown how many suicide decedents were not tested for alcohol. CONCLUSIONS Alcohol use is common factor contributing to suicide, particularly among young and middle-aged male adults. Alcohol use is also associated more strongly with certain methods of suicide. Further studies and more detailed data exploring alcohol consumption and suicide risks are needed in countries such as Kazakhstan.
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Tubbs AS, Taneja K, Ghani SB, Nadorff MR, Drapeau CW, Karp JF, Fernandez FX, Perlis ML, Grandner MA. Sleep continuity, timing, quality, and disorder are associated with suicidal ideation and suicide attempts among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-9. [PMID: 36596225 DOI: 10.1080/07448481.2022.2155828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 09/12/2022] [Accepted: 10/23/2022] [Indexed: 06/17/2023]
Abstract
Objective: To evaluate sleep continuity, timing, quality, and disorder in relation to suicidal ideation and attempts among college students. Participants: Eight hundred eighty-five undergraduates aged 18-25 in the southwestern United States. Methods: Participants completed questionnaires on sleep, suicide risk, mental health, and substance use. Differences in sleep variables were compared by lifetime and recent suicidal ideation and suicide attempts using covariate-adjusted and stepwise regression models. Results: A total of 363 (41.0%) individuals reported lifetime suicidal ideation, of whom 172 (47.4%) reported suicidal ideation in the last 3 months and 97 (26.7%) had attempted suicide in their lifetime. Sleep disturbances were prevalent among those with lifetime suicidal ideation or a lifetime suicide attempt. Insomnia was identified as the best predictor of recent suicidal ideation, but this relationship did not survive adjustment for covariates. Conclusions: Sleep continuity, quality, and sleep disorders are broadly associated with suicidal thoughts and behaviors among college students.
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Affiliation(s)
- Andrew S Tubbs
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | - Krishna Taneja
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | - Sadia B Ghani
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Mississippi, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Christopher W Drapeau
- Department of Health Policy and Management, School of Public Health, Indiana University, Indianapolis, Indiana, USA
- Division of Mental Health and Addiction, Indiana Family and Social Services Administration, Indianapolis, Indiana, USA
| | - Jordan F Karp
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | | | - Michael L Perlis
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael A Grandner
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
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Grove JL, April LY, Evan MK. Social Support as Protective Factor for Suicidal Ideation during Treatment for Substance Abuse: Differential Effects across Treatment Modalities. CURRENT RESEARCH IN BEHAVIORAL SCIENCES 2022. [DOI: 10.1016/j.crbeha.2022.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Rauch SAM, Steimle LN, Li J, Black K, Nylocks KM, Patton SC, Wise A, Watkins LE, Stojek MM, Maples-Keller JL, Rothbaum BO. Frequency and correlates of suicidal ideation and behaviors in treatment-seeking Post-9/11 Veterans. J Psychiatr Res 2022; 155:559-566. [PMID: 36201968 DOI: 10.1016/j.jpsychires.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Post-9/11 U.S. veterans and servicemembers are at increased risk for suicide, indicating an important need to identify and mitigate suicidal ideation and behaviors in this population. METHOD Using data modeling techniques, we examined correlates of suicidal ideation and behavior at intake in 261 Post-9/11 veterans and servicemembers seeking mental health treatment. RESULTS Our sample endorsed high rates of suicidal ideation and behavior. Approximately 40% of our sample scored in a range on the Suicide Behaviors Questionnaire-Revised (SBQ-R), indicating high clinical risk for suicide. Results from multivariate analyses indicate that greater state and/or trait depression severity, greater anger and anger expression, less impulse control, and lower rank were consistently associated with suicidal ideation and behavior across our models. Negative posttraumatic thoughts about the self, gender, and military branch of service were also significantly associated with suicidal ideation and behavior. CONCLUSIONS Suicidal ideation and behaviors are common in veterans seeking mental health treatment. State and/or trait depression, anger and impulse control were predictors of increased risk for suicidal ideation and behavior across models. Consistencies and differences across models as well as limitations and practical implications for the findings are discussed.
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Affiliation(s)
- Sheila A M Rauch
- Emory University School of Medicine, USA; Atlanta VA Healthcare System (AVAHCS), USA.
| | - Lauren N Steimle
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, USA
| | - Jingyu Li
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, USA
| | | | | | | | - Anna Wise
- Emory University School of Medicine, USA
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Blakey SM, Griffin SC, Grove JL, Peter SC, Levi RD, Calhoun PS, Elbogen EB, Beckham JC, Pugh MJ, Kimbrel NA. Comparing psychosocial functioning, suicide risk, and nonsuicidal self-injury between veterans with probable posttraumatic stress disorder and alcohol use disorder. J Affect Disord 2022; 308:10-18. [PMID: 35398395 PMCID: PMC9133145 DOI: 10.1016/j.jad.2022.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/19/2022] [Accepted: 04/03/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are each common among Unites States (U.S.) military veterans and frequently co-occur (i.e., PTSD+AUD). Although comorbid PTSD+AUD is generally associated with worse outcomes relative to either diagnosis alone, some studies suggest the added burden of comorbid PTSD+AUD is greater relative to AUD-alone than to PTSD-alone. Furthermore, nonsuicidal self-injury (NSSI) is more common among veterans than previously thought but rarely measured as a veteran psychiatric health outcome. This study sought to replicate and extend previous work by comparing psychosocial functioning, suicide risk, and NSSI among veterans screening positive for PTSD, AUD, comorbid PTSD+AUD, and neither disorder. METHODS This study analyzed data from a national sample of N = 1046 U.S. veterans who had served during the Gulf War. Participants self-reported sociodemographic, functioning, and clinical information through a mailed survey. RESULTS Veterans with probable PTSD+AUD reported worse psychosocial functioning across multiple domains compared to veterans with probable AUD, but only worse functioning related to controlling violent behavior when compared to veterans with probable PTSD. Veterans with probable PTSD+AUD reported greater suicidal ideation and NSSI than veterans with probable AUD, but fewer prior suicide attempts than veterans with probable PTSD. LIMITATIONS This study was cross-sectional, relied on self-report, did not verify clinical diagnoses, and may not generalize to veterans of other military conflicts. CONCLUSIONS Findings underscore the adverse psychiatric and functional outcomes associated with PTSD and comorbid PTSD+AUD, such as NSSI, and highlight the importance of delivering evidence-based treatment to this veteran population.
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Affiliation(s)
- Shannon M Blakey
- Durham VA Health Care System, Durham, NC, United States of America; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, United States of America; RTI International, Research Triangle Park, NC, United States of America.
| | - Sarah C Griffin
- Durham VA Health Care System, Durham, NC, United States of America; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, United States of America
| | - Jeremy L Grove
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Samuel C Peter
- Durham VA Health Care System, Durham, NC, United States of America
| | - Ryan D Levi
- Durham VA Health Care System, Durham, NC, United States of America
| | - Patrick S Calhoun
- Durham VA Health Care System, Durham, NC, United States of America; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, United States of America; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Eric B Elbogen
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, United States of America; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America; VA National Center on Homelessness Among Veterans, Tampa, FL, United States of America
| | - Jean C Beckham
- Durham VA Health Care System, Durham, NC, United States of America; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, United States of America; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Mary J Pugh
- VA Salt Lake City Healthcare System, Salt Lake City, UT, United States of America; University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Nathan A Kimbrel
- Durham VA Health Care System, Durham, NC, United States of America; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, United States of America; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America
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Kaurin A, Dombrovski AY, Hallquist MN, Wright AGC. Integrating a functional view on suicide risk into idiographic statistical models. Behav Res Ther 2022; 150:104012. [PMID: 35121378 PMCID: PMC8920074 DOI: 10.1016/j.brat.2021.104012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/11/2021] [Accepted: 11/27/2021] [Indexed: 12/17/2022]
Abstract
Acute risk of death by suicide manifests in heightened suicidal ideation in certain contexts and time periods. These increases are thought to emerge from complex and mutually reinforcing relationships between dispositional vulnerability factors and individually suicidogenic short-term stressors. Together, these processes inform clinical safety planning and our therapeutic tools accommodate a reasonable degree of idiosyncrasy when we individualize interventions. Unraveling these multifaceted factors and processes on a quantitative level, however, requires estimation frameworks capable of representing idiosyncrasies relevant to intervention and psychotherapy. Using, data from a 21-day ambulatory assessment protocol that included six random prompts per day, we developed personalized (i.e., idiographic) models of interacting risk factors and suicidal ideation via Group Iterative Multiple Model Estimation (GIMME) in a sample of people diagnosed with borderline personality disorder (N = 95) stratified for a history of high lethality suicide attempts. Our models revealed high levels of heterogeneity in state risk factors related to suicidal ideation, with no features shared among the majority of participants or even among relatively homogenous clusters of participants (i.e., empirically derived subgroups). We discuss steps toward clinical implementation of personalized models, which can eventually capture suicidogenic changes in proximal risk factors and inform safety planning and interventions.
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Affiliation(s)
- Aleksandra Kaurin
- Faculty of Health/School of Psychology and Psychiatry, Witten/Herdecke University, Witten, Germany.
| | | | - Michael N Hallquist
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, USA
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Panza KE, Kline AC, Na PJ, Potenza MN, Norman SB, Pietrzak RH. Epidemiology of DSM-5 alcohol use disorder in U.S. military veterans: Results from the National Health and Resilience in Veterans Study. Drug Alcohol Depend 2022; 231:109240. [PMID: 34974271 DOI: 10.1016/j.drugalcdep.2021.109240] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) is a prevalent public health concern in the U.S. that disproportionately affects veterans relative to civilians. Given changes to the demographic composition of the veteran population and AUD diagnostic criteria in the DSM-5, updated knowledge regarding the epidemiology of DSM-5 AUD in a national sample of veterans is critical to informing the population-based burden of this disorder. METHODS Data were analyzed from the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 4069 U.S. veterans. Lifetime DSM-5 AUD (mild, moderate, severe) and past-year DSM-5 AUD were assessed using validated self-report measures, and sociodemographic, military, and psychiatric characteristics associated with lifetime and past-year AUD were evaluated. RESULTS Prevalences of lifetime and past-year DSM-5 AUD were 40.8% (95% confidence interval [CI]=39.2-42.3%) and 10.5% (95%CI=9.6-11.5%), respectively. Lifetime prevalences of mild, moderate, and severe AUD were 20.5%, 8.3%, and 12.0%, respectively. Veterans with lifetime AUD had elevated rates of psychiatric disorders and suicidal behavior, which generally increased as a function of AUD severity. Lifetime AUD was also associated with being younger, male, white, unmarried, retired and experiencing more adverse childhood experiences and traumas. For past-year AUD, being younger, male, white, having more adverse childhood experiences, and experiencing lifetime PTSD were significant correlates. CONCLUSIONS AUD is highly prevalent among U.S. veterans and associated with substantial psychopathology, including elevated odds of suicidal behaviors. Results underscore the importance of comprehensive screening and preventive efforts for AUD, and interventions that concurrently target overlapping alcohol use and psychiatric difficulties.
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Affiliation(s)
- Kaitlyn E Panza
- VA San Diego Healthcare System, San Diego, CA 92161, USA; Department of Psychiatry, University of California, San Diego, CA 92093, USA.
| | - Alexander C Kline
- VA San Diego Healthcare System, San Diego, CA 92161, USA; Department of Psychiatry, University of California, San Diego, CA 92093, USA
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06516, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06516, USA; Department of Neuroscience, Yale University, New Haven, CT 06516, USA; Child Study Center, Yale School of Medicine, New Haven, CT 06516, USA; Connecticut Mental Health Center, New Haven, CT 06516, USA; Connecticut Council on Problem Gambling, Wethersfield, CT 06109, USA
| | - Sonya B Norman
- VA San Diego Healthcare System, San Diego, CA 92161, USA; Department of Psychiatry, University of California, San Diego, CA 92093, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA; National Center for PTSD, White River Junction, VT 05009, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06516, USA; National Center for PTSD, West Haven, CT 06516, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06511, USA
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Brüdern J, Glaesmer H, Berger T, Spangenberg L. Understanding suicidal pathways through the lens of a Dual-System Model of Suicidality in real-time: The potential of ecological momentary assessments. Front Psychiatry 2022; 13:899500. [PMID: 36518367 PMCID: PMC9742465 DOI: 10.3389/fpsyt.2022.899500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
Within the ideation-to-action framework, existing theories of suicidal thoughts and behaviors (STBs) primarily focus on the linear progression of suicide risk. This, however, neglects growing evidence that many suicidal individuals do not experience their suicide attempt as a planned action, and in some instances deny even having experienced any suicidal thoughts. Furthermore, recent research has found that risk factors differ substantially between persons and that this is reflected in the variety of suicidal pathways. Considering the strong variability of STBs, new innovative theoretical concepts and assessment methods are needed to advance our understanding of multiple suicidal pathways. In this review, we apply a dual-system framework to suicidality, the Dual-System Model of Suicidality (DSMS), which accounts for two different systems of information processing and behavior. The first of these described is the reflective system, whereby STBs are viewed from a self-regulation perspective and thusly considered as maladaptive coping behavior to perceived discrepancies regarding important goals. Applying a feedback-based view such as this to STBs provides a deeper understanding into underlying psychological processes involved in the development of STBs. The second system described by the DSMS is the impulsive system. Here, STBs are seen as a maladaptive self-organizing pattern that gets activated in high-risk situations of acute stress, negative affect, and when resources of the reflective system are depleted. In this context, the DSMS is informed by a strength model of self-regulation, which assumes that self-regulation resources are limited, an aspect with important theoretical and clinical implications for the development of STBs. In order to demonstrate the theoretical and practical utility of the DSMS, this review draws mainly on studies using ecological momentary assessment (EMA), a technology that allows to investigate moment-to-moment changes in STBs, and is therefore well suited for capturing the complex interplay of self-regulatory and impulsive processes proposed by the DSMS. The application of a dual-system framework to suicide research represents an innovative and integrative approach for expanding our knowledge about fundamental processes and how their dynamics lead to STBs. The usefulness of the DSMS, implications for future suicide research with EMA, and clinical implications are discussed.
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Affiliation(s)
- Juliane Brüdern
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
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Witt K, Chitty KM, Wardhani R, Värnik A, de Leo D, Kõlves K. Effect of alcohol interventions on suicidal ideation and behaviour: A systematic review and meta-analysis. Drug Alcohol Depend 2021; 226:108885. [PMID: 34198137 DOI: 10.1016/j.drugalcdep.2021.108885] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Alcohol consumption is related to both suicidal ideation and behaviour, but evidence regarding the effect of psychological interventions to reduce alcohol use on self-harm, suicidal behaviour and ideation is limited. Therefore, the aim of the current study was to conduct a systematic literature review and meta-analysis of the effect of alcohol-related psychological interventions on these outcomes at the individual level. METHODS We searched the Cochrane CENTRAL, Cochrane DARE, EMBASE, Medline, ProQuest, PsycINFO, PubMed, SCOPUS, and Web of Science electronic databases to 5 January 2021. We included all English-language papers worldwide utilising psychological interventions with a focus on harmful alcohol use and suicidal ideation, self-harm, and/or suicidal behaviour. RESULTS We identified 11 studies, nine provided sufficient numerical data for meta-analysis. Although the methods and effect sizes varied substantially in the studies, reducing alcohol may led to a reduction in self-harm and suicide attempt by the final follow-up assessment (Odds ratio [OR] 0.57, 95% confidence interval [CI] 0.33 to 0.97, 6 studies, 491 participants, I2 = 0%). However, there was no apparent effect for these interventions on suicidal ideation or suicide deaths. There was no significant difference in effect by therapeutic approach. Neither intervention dose (in hours) nor duration (in months) significantly explained differences in treatment effectiveness. CONCLUSIONS Interventions targeting harmful alcohol consumption may contribute towards a reduction in self-harm at the individual level. However, there was no apparent effect of these interventions on suicidal ideation (measured either continuously or dichotomously) or suicide deaths.
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Affiliation(s)
- Katrina Witt
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Kate M Chitty
- Clinical Pharmacology and Toxicology Research Group, Faculty of Medicine and Health, Discipline of Pharmacology, University of Sydney, Sydney, Australia
| | - Rachmania Wardhani
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Airi Värnik
- Tallinn University, Tallinn, Estonia; Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia
| | - Diego de Leo
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia.
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Hill ML, Nichter B, Loflin M, Norman SB, Pietrzak RH. Comparative associations of problematic alcohol and cannabis use with suicidal behavior in U.S. military veterans: A population-based study. J Psychiatr Res 2021; 135:135-142. [PMID: 33477057 DOI: 10.1016/j.jpsychires.2021.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/09/2020] [Accepted: 01/04/2021] [Indexed: 12/18/2022]
Abstract
Alcohol use disorder (AUD) and cannabis use disorder (CUD) are each associated with increased suicidal behavior, but it is unclear how their comorbidity relates to suicide risk. Understanding these associations in U.S. military veterans is especially important, given their heightened risk for suicide, high prevalence of AUD, and increasing access to cannabis. We compared associations of probable AUD, CUD, and AUD/CUD with suicide ideation, plan(s), and attempt(s) in a nationally representative sample of 4,069 veterans surveyed in 2019-2020 as part of the National Health and Resilience in Veterans Study. Among veterans who screened positive for current AUD, 8.7% also screened positive for current CUD. Among veterans who screened positive for current CUD, 33.3% screened positive for current AUD. Current and lifetime positive screens for AUD, CUD, and AUD/CUD were each strongly and independently associated with past-year suicide ideation and lifetime suicide ideation, plan(s), and attempt(s) [odds ratios (ORs) = 1.6-8.7]. Relative to veterans who screened positive for AUD only, veterans who screened positive for AUD/CUD and CUD only had higher odds of past-year suicide ideation (AUD/CUD: OR = 3.3; CUD only: OR = 2.4), lifetime suicide ideation (AUD/CUD: OR = 1.9; CUD only: OR = 2.6) and lifetime suicide plan(s) (AUD/CUD: OR = 1.7; CUD only: OR = 6.1). Collectively, findings suggest that screening positive for CUD might be an especially strong indicator of suicide ideation and planning in veterans with and without AUD, independent of sociodemographic, military, trauma, and other psychiatric factors. These findings underscore the importance of routine screening for CUD in suicide prevention efforts, especially as cannabis becomes more widely available.
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Affiliation(s)
- Melanie L Hill
- Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA.
| | - Brandon Nichter
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Mallory Loflin
- Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; National Center for PTSD, White River Junction, VT, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; National Center for PTSD, White River Junction, VT, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Robert H Pietrzak
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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14
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Conner KR, Kearns JC, Esposito EC, Pizzarello E, Wiegand TJ, Britton PC, Michel K, Gysin-Maillart AC, Goldston DB. Pilot RCT of the Attempted Suicide Short Intervention Program (ASSIP) adapted for rapid delivery during hospitalization to adult suicide attempt patients with substance use problems. Gen Hosp Psychiatry 2021; 72:66-72. [PMID: 34304029 PMCID: PMC8448954 DOI: 10.1016/j.genhosppsych.2021.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The Attempted Suicide Short Intervention Program (ASSIP) was adapted for hospital delivery and to address substance use problems as well as evaluated for feasibility, acceptability, and therapist fidelity in a series of preparatory steps (n = 28) and in a pilot randomized controlled trial, RCT (n = 34). METHOD In the RCT, patients with suicide attempts and substance use problem(s) with sufficient lengths of stay to deliver three ASSIP therapy sessions in hospital were randomized to adapted ASSIP or treatment as usual control. A blinded assessor identified suicide reattempts over 6-month follow-up with the Columbia-Suicide Severity Rating Scale (C-SSRS) and a comprehensive multi-source method. Treatment process measures and the Scale for Suicidal Ideation (SSI) were also administered. RESULTS Median hospital stay was 13 days. ASSIP subjects reported high satisfaction with the treatment and high therapeutic alliance. Study therapists showed high fidelity to the modified ASSIP intervention. Repetition of suicide attempt was common in both study groups including a combined 9 (26%) subjects with reattempt based on C-SSRS and 13 (38%) subjects with reattempt based on multiple sources. CONCLUSIONS Adult suicide attempt patients with substance use problems who require lengthy hospitalizations are at exceptionally high risk and may require additional strategies to lower risk.
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Affiliation(s)
| | - Jaclyn C. Kearns
- Department of Psychology, University of Rochester, Rochester, NY, USA
| | - Erika C. Esposito
- Department of Psychology, University of Rochester, Rochester, NY, USA
| | | | | | - Peter C. Britton
- University of Rochester Medical Center, Rochester, NY, USA,Center of Excellence for Suicide Prevention, Finger Lakes VA Healthcare System, Canandaigua, NY, USA
| | - Konrad Michel
- University Hospital of Psychiatry, Bern, Switzerland
| | - Anja C. Gysin-Maillart
- Translational Research Centre, University Hospital of Psychiatry, University of Bern, Switzerland,Unit for Clinical Suicide Research, Department of Clinical Sciences, Psychiatry, Faculty of Medicine, Lund University, Sweden,University of Leipzig Department of Medical Psychology and Medical Sociology
| | - David B. Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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15
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Li E, Hing N, Russell AMT, Vitartas P. Impulsive Sports Betting: The Effects of Food or Substance Consumption. J Gambl Stud 2020; 36:539-554. [PMID: 32266648 DOI: 10.1007/s10899-020-09938-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The present study aimed to explore how food or substance consumption (e.g., experiencing hunger, or having consumed alcohol or recreational drugs) could shape consumer impulsive spending on sports betting products. Based on a large online sample of Australian sports bettors, we found that participants with higher hunger level, or having consumed more alcohol or recreational drugs, tended to have increased impulsive bet size. These impulsiveness effects had both direct and indirect effect components. The significant direct effects confirmed that positive relationships directly existed between hunger, alcohol consumption, or recreational drug consumption and impulsive bet size, even when all potential mediators and covariates were statistically controlled. Moreover, results regarding specific indirect effects demonstrated that hunger, alcohol consumption, or recreational drug consumption was also indirectly linked with impulsive bet size, via their relationships with both promotional and financial influences, rather than social influences. Furthermore, participants' Problem Gambling Severity Index score was positively associated with their impulsive bet size. These findings support and complement the literature on impulsivity as well as the research on strategies for staying in control of gambling, and have implications for consumers, regulators, and treatment/help providers.
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Affiliation(s)
- En Li
- Experimental Gambling Research Laboratory, School of Business and Law, CQUniversity, Rockhampton, QLD, Australia.
| | - Nerilee Hing
- Experimental Gambling Research Laboratory, School of Health, Medical and Applied Sciences, CQUniversity, Bundaberg, QLD, Australia
| | - Alex M T Russell
- Experimental Gambling Research Laboratory, School of Health, Medical and Applied Sciences, CQUniversity, Sydney, NSW, Australia
| | - Peter Vitartas
- Department of Entrepreneurship, Innovation and Marketing, La Trobe Business School, La Trobe University, Bundoora, VIC, Australia
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16
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Bryan CJ, Butner JE, May AM, Rugo KF, Harris J, Oakey DN, Rozek DC, Bryan AO. Nonlinear change processes and the emergence of suicidal behavior: a conceptual model based on the fluid vulnerability theory of suicide. NEW IDEAS IN PSYCHOLOGY 2020; 57:10.1016/j.newideapsych.2019.100758. [PMID: 32123464 PMCID: PMC7050543 DOI: 10.1016/j.newideapsych.2019.100758] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Although ideation-to-action theories of suicide aim to explain the emergence of suicidal behaviors, researchers have primarily focused on the content of underlying mechanisms (i.e., who dies by suicide). Much less attention has focused on the temporal dynamics of suicide risk (i.e., when suicide occurs). The fluid vulnerability theory conceptualizes suicide as an inherently dynamic construct that follows a nonlinear time course. Newer research implicates the existence of multiple nonlinear change processes among suicidal individuals, some of which appear to be associated with the emergence of suicidal behavior. The cusp catastrophe model provides a useful model for conceptualizing these change processes and provides a foundation for explaining a number of poorly understood phenomena including sudden emergence of suicidal behavior without prior suicidal planning. The implications of temporal dynamics for suicide-focused theory, practice, and research are discussed.
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Affiliation(s)
- Craig J Bryan
- National Center for Veterans Studies & The University of Utah
| | | | | | - Kelsi F Rugo
- National Center for Veterans Studies & The University of Utah
| | - Julia Harris
- National Center for Veterans Studies & The University of Utah
| | - D Nicolas Oakey
- National Center for Veterans Studies & The University of Utah
| | - David C Rozek
- National Center for Veterans Studies & The University of Utah
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17
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Short-term risk of suicide attempt associated with patterns of patient-reported alcohol use determined by routine AUDIT-C among adults receiving mental healthcare. Gen Hosp Psychiatry 2020; 62:79-86. [PMID: 31874300 PMCID: PMC7047881 DOI: 10.1016/j.genhosppsych.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the association between alcohol use routinely reported during outpatient mental healthcare visits and short-term risk of subsequent suicide attempt. METHODS Using a longitudinal retrospective-cohort design, electronic health records identified adult outpatient visits to a mental health provider (1/1/2010-6/30/2015) at Kaiser Permanente Washington with a documented Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]. Suicide attempts within 90 days of AUDIT-C documentation were defined using death certificate cause-of-death and diagnosis codes (non-lethal). Visit-level analyses used generalized estimating equations to account for correlation between multiple AUDIT-Cs for individuals. Separate models evaluated the association between (1) level of consumption and (2) frequency of heavy drinking episodes and suicide attempts, adjusted for visit year, demographics, depressive symptom, and suicidal ideation. RESULTS Of 59,382 patient visits, 0.62% (N = 371) were followed by a suicide attempt within 90 days. Patients reporting high-level alcohol use were 1.77 times (95% CI, 1.22-2.57) more likely to attempt suicide than those reporting low-level use. Patients reporting daily or almost daily heavy drinking episodes were 2.33 times (95% CI, 1.38-3.93) more likely to attempt suicide than those reporting none. CONCLUSIONS AND RELEVANCE The AUDIT-C is a valuable tool for assessing patterns of patient-reported alcohol use associated with subsequent suicide attempt.
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18
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Simons JS, Simons RM, Walters KJ, Keith JA, O'Brien C, Andal K, Stoltenberg SF. Nexus of despair: A network analysis of suicidal ideation among veterans. Arch Suicide Res 2020; 24:314-336. [PMID: 30734645 PMCID: PMC7206527 DOI: 10.1080/13811118.2019.1574689] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The objective of this study was to estimate a network model of risk and resilience factors of suicidal ideation among veterans. Two network models of suicidal ideation among Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn veterans (N = 276) incorporated key disorders, traumatic stress, and resilience constructs to contextualize suicidal ideation. Childhood trauma was positively connected with suicidal ideation and harassment and inversely connected with social support and distress tolerance. This exemplifies long-lasting associations between childhood trauma and re-victimization, emotion regulation, and ability to form supportive social relationships. A subsequent model including lower-order facets indicated that combat trauma was predominantly associated with posttraumatic stress disorder-intrusion symptoms. This study highlights the importance of addressing both risk and resilience to reduce suicide risk among veterans and increases understanding of factors that contribute to suicidal ideation.
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Affiliation(s)
- Jeffrey S Simons
- The University of South Dakota, Vermillion, South Dakota.,Sioux Falls VA Health Care System, Sioux Falls, South Dakota
| | - Raluca M Simons
- The University of South Dakota, Vermillion, South Dakota.,Sioux Falls VA Health Care System, Sioux Falls, South Dakota
| | - Kyle J Walters
- The University of South Dakota, Vermillion, South Dakota
| | | | | | - Kate Andal
- Sioux Falls VA Health Care System, Sioux Falls, South Dakota
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19
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Substance use and suicidal ideation among child welfare involved adolescents: A longitudinal examination. Addict Behav 2019; 93:39-45. [PMID: 30684820 DOI: 10.1016/j.addbeh.2019.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/27/2018] [Accepted: 01/14/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the longitudinal predictors of alcohol use, marijuana use, and suicidal ideation among maltreated adolescents. METHODS Longitudinal data from this study come from three waves of the National Survey of Child and Adolescent Wellbeing II (NSCAW II). Participants included 1050 adolescents (Mage = 14.13) who were subjects of child abuse or neglect investigations. Items from the Health Risk Behavior Questionnaire were used to measure alcohol and marijuana use. Suicidal ideation was measured using an item from the Childhood Depression Inventory. Data on deviant peer affiliation, caregiver health, maltreatment type, age, race, and gender were also collected. RESULTS Marijuana use, suicidal ideation, caregiver drug abuse, deviant peer affiliation, age, and race were predictive of alcohol use. Alcohol use, deviant peer affiliation, age, and time were predictive of marijuana use. Alcohol use, deviant peer affiliation, age, and gender predicted suicidal ideation. CONCLUSIONS Longitudinal evidence indicated that individual, family, and peer factors played an important role in predicting alcohol use, marijuana use, and suicidal ideation among child welfare involved adolescents. In addition, this study provides evidence of a potentially reciprocal relationship between alcohol use and suicidal ideation among this population. Intervention efforts for reducing the public health problems of substance use and suicide among child welfare involved adolescents should focus on the importance of peers in influencing thoughts and behaviors, as well as the functional relationship between alcohol use and suicidal ideation.
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20
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Why do trauma survivors become depressed? Testing the behavioral model of depression in a nationally representative sample. Psychiatry Res 2019; 272:587-594. [PMID: 30616128 DOI: 10.1016/j.psychres.2018.12.150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/28/2018] [Accepted: 12/28/2018] [Indexed: 11/23/2022]
Abstract
Despite accumulated evidence linking trauma exposure to major depressive disorder (MDD), there is limited understanding as to why some trauma survivors subsequently develop MDD. The behavioral model of depression points to a negative reinforcement cycle of trauma-related avoidance and depressed mood, but no study has evaluated this framework in trauma survivors. This study tested the hypothesis that traumatic stress symptom-related interference with daily activities and with relationships and self-medicating traumatic stress symptoms with alcohol and with drugs would predict MDD onset in a nationally representative sample after controlling for established risk factors. Data were drawn from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) using two samples: adults reporting lifetime trauma exposure but no history of MDD at Wave 1 (n = 8301) and a subset of those participants who met criteria for lifetime PTSD prior to Wave 1 (n = 1055). Younger age, female gender, a greater number of different trauma types, traumatic stress-related interference with daily activities, and self-medicating traumatic stress symptoms with alcohol significantly predicted MDD onset in both groups. Findings underscore the role of traumatic stress-related interference and self-medication in the development of MDD.
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21
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Conner KR, Bagge CL. Suicidal Behavior: Links Between Alcohol Use Disorder and Acute Use of Alcohol. Alcohol Res 2019; 40:arcr.v40.1.02. [PMID: 31649836 PMCID: PMC6799956 DOI: 10.35946/arcr.v40.1.02] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Research on associations of suicidal behavior, including suicide and suicide attempt, with alcohol use disorder (AUD) and acute use of alcohol (AUA) are discussed, with an emphasis on data from meta-analyses. Based on psychological autopsy investigations, results indicate that AUD is prevalent among individuals who die by suicide. Results also indicate that AUD is a potent risk factor for suicidal behavior. Risk estimates are higher for individuals with AUD in treatment settings, when compared to individuals in the community who have AUD. Also, although rates of suicide and prevalence of AUD remain higher in men, they have increased more among women in recent decades. Based on postmortem blood alcohol concentrations, AUA was commonly present among those who died by suicide. AUA is a potent proximal risk factor for suicidal behavior, and the risk increases with the amount of alcohol consumed, consistent with a dose-response relationship. Research indicates that AUA increases risk for suicidal behavior by lowering inhibition and promoting suicidal thoughts. There is support for policies that serve to reduce alcohol availability in populations with high rates of AUD and suicide, that promote AUD treatment, and that defer suicide risk assessments in intoxicated patients to allow the blood alcohol concentration to decrease.
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Affiliation(s)
- Kenneth R Conner
- Kenneth R. Conner, Psy.D., M.P.H., is a professor in the Departments of Emergency Medicine and Psychiatry, University of Rochester Medical Center, Rochester, New York. Courtney L. Bagge, Ph.D., is an associate professor in the Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
| | - Courtney L Bagge
- Kenneth R. Conner, Psy.D., M.P.H., is a professor in the Departments of Emergency Medicine and Psychiatry, University of Rochester Medical Center, Rochester, New York. Courtney L. Bagge, Ph.D., is an associate professor in the Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
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22
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McManama O’Brien KH, Aguinaldo LD, White E, Sellers CM, Spirito A. A Brief Alcohol Intervention During Inpatient Psychiatric Hospitalization for Suicidal Adolescents. COGNITIVE AND BEHAVIORAL PRACTICE 2018. [DOI: 10.1016/j.cbpra.2017.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Clinical Prediction of Suicide and Undetermined Death: A Pseudo-Prospective Clinical and Medico-Legal Study of Substance Abusers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030310. [PMID: 28304357 PMCID: PMC5369146 DOI: 10.3390/ijerph14030310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/01/2017] [Accepted: 03/14/2017] [Indexed: 12/02/2022]
Abstract
This study examines aspects of prediction of suicide and death of undetermined intent. We investigated all consecutive, autopsied patients between 1993 and 1997 who had been in contact with the Addiction Centre in Malmö from 1968 onwards. The staff was asked, shortly after autopsy but before they knew of the manner of death, if they thought the patient had committed suicide. The case records were blindly evaluated, and toxicological autopsy findings for alcohol in blood samples investigated. The specificity of prediction was 83% and significantly more often correct than the sensitivity, which was only 45% for suicide and for suicide/death of undetermined intent (93% versus 39%). Suicidal communication was more often considered non-serious before death of undetermined intent than before suicide. The former could be predicted by ideation but not by suicide attempt reported in case records, unlike suicide, which was predicted by both. The undetermined group also showed higher levels of alcohol in the blood at autopsy. We concluded that more serious clinical investigation of suicidal feelings, which may be hidden and not taken seriously, and treatment of alcohol use disorders with active follow-up appear urgent in the efforts to prevent suicide.
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